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110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-568

======================================================================



 
                             WAKEFIELD ACT

                                _______
                                

 April 8, 2008.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2464]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2464) to amend the Public Health Service Act to 
provide a means for continued improvement in emergency medical 
services for children, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     7

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Wakefield Act''.

SEC. 2. FINDINGS AND PURPOSE.

  (a) Findings.--Congress makes the following findings:
          (1) There are 31,000,000 child and adolescent visits to the 
        Nation's emergency departments every year.
          (2) Over 90 percent of children requiring emergency care are 
        seen in general hospitals, not in free-standing children's 
        hospitals, with one-quarter to one-third of the patients being 
        children in the typical general hospital emergency department.
          (3) Severe asthma and respiratory distress are the most 
        common emergencies for pediatric patients, representing nearly 
        one-third of all hospitalizations among children under the age 
        of 15 years, while seizures, shock, and airway obstruction are 
        other common pediatric emergencies, followed by cardiac arrest 
        and severe trauma.
          (4) Up to 20 percent of children needing emergency care have 
        underlying medical conditions such as asthma, diabetes, sickle-
        cell disease, low birth weight, and bronchopulmonary dysplasia.
          (5) Significant gaps remain in emergency medical care 
        delivered to children. Only about 6 percent of hospitals have 
        available all the pediatric supplies deemed essential by the 
        American Academy of Pediatrics and the American College of 
        Emergency Physicians for managing pediatric emergencies, while 
        about half of hospitals have at least 85 percent of those 
        supplies.
          (6) Providers must be educated and trained to manage 
        children's unique physical and psychological needs in emergency 
        situations, and emergency systems must be equipped with the 
        resources needed to care for this especially vulnerable 
        population.
          (7) Systems of care must be continually maintained, updated, 
        and improved to ensure that research is translated into 
        practice, best practices are adopted, training is current, and 
        standards and protocols are appropriate.
          (8) The Emergency Medical Services for Children (EMSC) 
        Program under section 1910 of the Public Health Service Act (42 
        U.S.C. 300w-9) is the only Federal program that focuses 
        specifically on improving the pediatric components of emergency 
        medical care.
          (9) The EMSC Program promotes the nationwide exchange of 
        pediatric emergency medical care knowledge and collaboration by 
        those with an interest in such care and is depended upon by 
        Federal agencies and national organizations to ensure that this 
        exchange of knowledge and collaboration takes place.
          (10) The EMSC Program also supports a multi-institutional 
        network for research in pediatric emergency medicine, thus 
        allowing providers to rely on evidence rather than anecdotal 
        experience when treating ill or injured children.
          (11) The Institute of Medicine stated in its 2006 report, 
        ``Emergency Care for Children: Growing Pains'', that the EMSC 
        Program ``boasts many accomplishments ... and the work of the 
        program continues to be relevant and vital''.
          (12) The EMSC Program has proven effective over two decades 
        in driving key improvements in emergency medical services to 
        children, and should continue its mission to reduce child and 
        youth morbidity and mortality by supporting improvements in the 
        quality of all emergency medical and emergency surgical care 
        children receive.
  (b) Purpose.--It is the purpose of this Act to reduce child and youth 
morbidity and mortality by supporting improvements in the quality of 
all emergency medical care children receive.

SEC. 3. REAUTHORIZATION OF EMERGENCY MEDICAL SERVICES FOR CHILDREN 
                    PROGRAM.

  Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is 
amended--
          (1) in subsection (a), by striking ``3-year period (with an 
        optional 4th year'' and inserting ``4-year period (with an 
        optional 5th year'';
          (2) in subsection (d)--
                  (A) by striking ``and such sums'' and inserting 
                ``such sums''; and
                  (B) by inserting before the period the following: ``, 
                $25,000,000 for fiscal year 2009, $26,250,000 for 
                fiscal year 2010, $27,562,500 for fiscal year 2011, 
                $28,940,625 for fiscal year 2012, and $30,387,656 for 
                fiscal year 2013'';
          (3) by redesignating subsections (b) through (d) as 
        subsections (c) through (e), respectively; and
          (4) by inserting after subsection (a) the following:
  ``(b)(1) The purpose of the program established under this section is 
to reduce child and youth morbidity and mortality by supporting 
improvements in the quality of all emergency medical care children 
receive, through the promotion of projects focused on the expansion and 
improvement of such services, including those in rural areas and those 
for children with special healthcare needs. In carrying out this 
purpose, the Secretary shall support emergency medical services for 
children by supporting projects that--
          ``(A) develop and present scientific evidence;
          ``(B) promote existing and innovative technologies 
        appropriate for the care of children; or
          ``(C) provide information on health outcomes and 
        effectiveness and cost-effectiveness.
  ``(2) The program established under this section shall--
          ``(A) strive to enhance the pediatric capability of emergency 
        medical service systems originally designed primarily for 
        adults; and
          ``(B) in order to avoid duplication and ensure that Federal 
        resources are used efficiently and effectively, be coordinated 
        with all research, evaluations, and awards related to emergency 
        medical services for children undertaken and supported by the 
        Federal Government.''.

                          Purpose and Summary

    The purpose of H.R. 2464, the ``Wakefield Act'', is to 
amend the Public Health Service Act to provide a means for 
continued improvement in emergency medical services for 
children.

                  Background and Need for Legislation

    Each year, injury alone claims more lives of children 
between the ages of 1 and 19 than do all forms of illness. 
Although Early Emergency Medical Services (EMS) systems were 
designed to provide rapid intervention for sudden cardiac 
arrest in adults and rapid transport for motor vehicle crash 
victims, there has been limited recognition that children 
require specialized care. Although EMS systems and hospital 
emergency departments are widely assumed to be equally capable 
of caring for children and adults, in fact, in many EMS 
systems, children's needs have been overlooked as services were 
developed for adult trauma and cardiac patients.
    H.R. 2464 reauthorizes the Emergency Medical Services for 
Children (EMSC) program within the U.S. Department of Health 
and Human Services (HHS). The EMSC program began in 1984 and is 
designed to ensure state-of-the-art emergency medical care for 
ill or injured children and adolescents. It covers the entire 
spectrum of emergency medical care. The EMSC program provides 
grants to States to improve existing EMS systems and to schools 
of medicine to develop and evaluate improved procedures and 
protocols for treating children.
    Since its establishment more than 20 years ago, the EMSC 
program has driven major improvements in emergency care for 
children. Injury-related deaths among children have dropped by 
40 percent over that period. Enormous strides have been made in 
areas such as ensuring that all ambulances carry appropriate 
pediatric equipment and supplies, establishing transfer 
protocols to assure that severely injured children are sent to 
the facilities best able to care for them, and collecting and 
analyzing data on pediatric emergency care to inform future 
efforts towards improvement.
    Although much progress has been achieved, more remains to 
be done. The EMSC program's authorization expired in September 
2005, and there are numerous important improvements that can be 
made to the program.

                                Hearings

    There were no hearings held in connection to the bill 
reported by the Committee.

                        Committee Consideration

    On Tuesday, March 11, 2008, the Subcommittee on Health met 
in open markup session and favorably forwarded H.R. 2464, 
amended, to the full Committee for consideration, by a voice 
vote. On Thursday, March 13, 2008, the full Committee met in 
open markup session and ordered H.R. 2464 favorably reported to 
the House, as amended by the Subcommittee on Health, by a voice 
vote. No amendments were offered during full Committee 
consideration.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 2464 reported to the House. A motion by Mr. 
Dingell to order H.R. 2464 favorably reported to the House, as 
amended, was agreed to by a voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the oversight findings of the 
Committee regarding H.R. 2464 are reflected in this report.

         Statement of General Performance Goals and Objectives

    The objective of H.R. 2464 is to extend by one year the 
length of time for which a grant may be awarded under the EMSC 
grant program, which allows the Secretary of HHS to make grants 
to States or schools of medicine to support projects to expand 
and improve EMS for children who need treatment for trauma or 
critical care. Furthermore, H.R. 2464 sets forth as the purpose 
of the program the reduction of child and youth morbidity and 
mortality by supporting improvements in the quality of all 
emergency medical care children receive. H.R. 2464 requires the 
Secretary of HHS to support emergency medical services for 
children by supporting projects that: (1) develop and present 
scientific evidence; (2) promote existing innovative 
technologies appropriate for the care of children; and (3) 
provide information on health outcomes and effectiveness and 
cost-effectiveness. Lastly, H.R. 2464 states that the EMSC 
program shall strive to enhance the pediatric capability of EMS 
systems and must be coordinated with all research, evaluations, 
and awards undertaken by the Federal Government related to EMS 
for children.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 2464 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 2464 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
2464 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate on 
H.R. 2464 provided by the Congressional Budget Office pursuant 
to section 402 of the Congressional Budget Act of 1974:

                                                     April 4, 2008.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2464, the 
Wakefield Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Mindy Cohen.
            Sincerely,
                                         Robert A. Sunshine
                                             (For Peter R. Orszag.)
    Enclosure.

H.R. 2464--Wakefield Act

    H.R. 2464 would amend the Public Health Service Act to 
direct the Secretary of Health and Human Services to provide 
grants to states and medical schools for several activities 
intended to reduce child and youth morbidity and mortality by 
improving emergency medical services for children.
    The bill would authorize the appropriation of $25 million 
for 2009 and $138 million over the 2009-2013 period for those 
purposes. Based on historical patterns of spending for similar 
activities, CBO estimates that implementing H.R. 2464 would 
cost $4 million in 2009 and $93 million over the 2009-2013 
period, assuming appropriation of the specified amounts. 
Enacting H.R. 2464 would have no effect on direct spending or 
revenues.
    H.R. 2464 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The estimated budgetary impact of H.R 2464 is shown in the 
following table. The costs of this legislation fall within 
budget function 550 (health).

------------------------------------------------------------------------
                                      By fiscal year, in millions of
                                                 dollars--
                                 ---------------------------------------
                                   2009    2010    2011    2012    2013
------------------------------------------------------------------------
              CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level.............      25      26      28      29      30
Estimated Outlays...............       4      15      23      27      24
------------------------------------------------------------------------

    The CBO staff contact for this estimate is Mindy Cohen. 
This estimate was approved by Keith J. Fontenot, Deputy 
Assistant Director for Health and Human Resources, Budget 
Analysis Division.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2464 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2464.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 2464 is provided in the 
provisions of Article I, section 8, clause 1, that relate to 
expending funds to provide for the general welfare of the 
United States.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 2464 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act of 1995.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title of the Act as the 
``Wakefield Act''.

Section 2. Findings and purpose

    Section 2 states the Congressional findings.

Section 3. Reauthorization of emergency medical services for children 
        program

    Section 3 of this legislation amends Section 1910 of the 
Public Health Service Act (42 U.S.C. 300w-9).
    Section 3 extends, by 1 year, the length of time for which 
a grant may be awarded under the EMSC program. The Secretary of 
HHS awards these grants to States or schools of medicine to 
support projects to expand and improve emergency medical 
services for children who need treatment for trauma or critical 
care.
    Section 3 sets forth as the purpose of the program the 
reduction of child and youth morbidity and mortality by 
supporting improvements in the quality of all emergency medical 
care children receive.
    Section 3 requires that the Secretary of HHS support 
emergency medical services for children by supporting projects 
that develop and present scientific evidence, which promote 
existing innovative technologies appropriate for the care of 
children, and which provide information on health outcomes, 
effectiveness, and cost-effectiveness.
    Section 3 states that the EMSC program shall strive to 
enhance the pediatric capability of EMS systems and, in order 
to avoid duplication, coordinate with all research, 
evaluations, and awards undertaken by the Federal Government 
related to EMS for children.
    Finally, Section 3 amends the authorization of 
appropriations for the EMSC program. H.R. 2464 changes ``such 
sums'' to $25,000,000 for fiscal year 2009, $26,250,000 for 
fiscal year 2010, $27,562,500 for fiscal year 2011, $28,940,625 
for fiscal year 2012, and $30,387,656 for fiscal year 2013. 
This change provides a 5 percent increase in authorizations for 
each fiscal year.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



                        TITLE XIX--BLOCK GRANTS


Part A--Preventive Health and Health Services Block Grant

           *       *       *       *       *       *       *



                EMERGENCY MEDICAL SERVICES FOR CHILDREN

  Sec. 1910. (a) For activities in addition to the activities 
which may be carried out by States under section 1904(a)(1)(F), 
the Secretary may make grants to States or accredited schools 
of medicine in States to support a program of demonstration 
projects for the expansion and improvement of emergency medical 
services for children who need treatment for trauma or critical 
care. Any grant made under this subsection shall be for not 
more than a [3-year period (with an optional 4th year] 4-year 
period (with an optional 5th year based on performance), 
subject to annual evaluation by the Secretary. Only 3 grants 
under this subsection may be made in a State (to a State or to 
a school of medicine in such State) in any fiscal year.
  (b)(1) The purpose of the program established under this 
section is to reduce child and youth morbidity and mortality by 
supporting improvements in the quality of all emergency medical 
care children receive, through the promotion of projects 
focused on the expansion and improvement of such services, 
including those in rural areas and those for children with 
special healthcare needs. In carrying out this purpose, the 
Secretary shall support emergency medical services for children 
by supporting projects that--
          (A) develop and present scientific evidence;
          (B) promote existing and innovative technologies 
        appropriate for the care of children; or
          (C) provide information on health outcomes and 
        effectiveness and cost-effectiveness.
  (2) The program established under this section shall--
          (A) strive to enhance the pediatric capability of 
        emergency medical service systems originally designed 
        primarily for adults; and
          (B) in order to avoid duplication and ensure that 
        Federal resources are used efficiently and effectively, 
        be coordinated with all research, evaluations, and 
        awards related to emergency medical services for 
        children undertaken and supported by the Federal 
        Government.
  [(b)] (c) The Secretary may renew a grant made under 
subsection (a) for one additional one-year period only if the 
Secretary determines that renewal of such grant will provide 
significant benefits through the collection, analysis, and 
dissemination of information or data which will be useful to 
States in which grants under such subsection have not been 
made.
  [(c)] (d) For purposes of this section--
          (1) * * *

           *       *       *       *       *       *       *

  [(d)] (e) To carry out this section, there are authorized to 
be appropriated $2,000,000 for fiscal year 1985 and for each of 
the two succeeding fiscal years, $3,000,000 for fiscal year 
1989, $4,000,000 for fiscal year 1990, $5,000,000 for each of 
the fiscal years 1991 and 1992, [and such sums] such sums as 
may be necessary for each of the fiscal years 1993 through 
2005, $25,000,000 for fiscal year 2009, $26,250,000 for fiscal 
year 2010, $27,562,500 for fiscal year 2011, $28,940,625 for 
fiscal year 2012, and $30,387,656 for fiscal year 2013.

           *       *       *       *       *       *       *